I haven't had any first hand experience of this latest round of organisational change in the English NHS, having left it to work in Scotland some years ago in horror at the Tory internal market 'reforms' that resulted in the mass-sacking of almost everyone I respected in NHS administration.

I haven't had any first hand experience of this latest round of organisational change in the English NHS, having left it to work in Scotland some years ago in horror at the Tory internal market 'reforms' that resulted in the mass-sacking of almost everyone I respected in NHS administration.

I'm not sure where that puts dear old Ken Jarrold, but wasn't he rather close to the reforms at the time ? The managers of the day were replaced with more compliant and politically acceptable general managers with shiny suits and BMWs.

Every time you passed the bosses' doors there were new job titles and even fancier remuneration packages, while in the engine room we middle management minions tried to hide between the pipes in the vain hope we would be overlooked when the axe fell next.

So I'm not really qualified to determine whether Ken is right or not in saying that this has been the 'worst-handled re-organisation in the history of the NHS'. But bitter experience shows ritual bloodletting seems to be an intrinsic and iterative aspect of NHS management culture. I would urge any young person of principle and ambition to think very carefully before taking up NHS management as a career. All the evidence is that just when you think it can't get any worse, it does.

Rob Kay, director, Paperclip, Scotland